Effects Of Gastrointestinal Tumor Surgery On Liver Cirrhosis Severity And Analysis Of Related Factors Of Postoperative Morbidity

Purpose:Liver cirrhosis and tumors are currently the main public health problems.Though surgery is the main curative option for patients with cancer,the fact is that the risk of surgery for patients with liver cirrhosis is much greater than that in patients without.At present,there are few studies on the analysis of factors affecting postoperative morbidities in patients with cirrhosis after gastrointestinal tumor.This study first analyzes the changes of liver function indexes in cirrhotic patients after radical resection of gastrointestinal tumors and summarizes the modality of morbidities,and then uses multivariate logistic regression analysis to estimate the risk factors for postoperative morbidities or major morbidities,aiming to clarify the effects of radical resection of gastrointestinal tumors on the condition of liver cirrhosis and estimate the risk factors of postoperative morbidities,in order to provide guidance about judging the benefits of radical resection of gastrointestinal tumors and perioperative care to cirrhotic patients.Methods:A retrospective case-control study was conducted.A total of 117 cirrhotic patients who underwent radical surgery for gastrointestinal tumors in Subei People’s Hospital of Jiangsu province from August 2012 to July 2020 were selected and afterwards the relevant clinical and surgical data were recorded.Firstly,liver function indexes on the1^st,7^th and 15^th day after operation were compared with those before operation.Then univariate analysis is used to screen out potential risk factors,taking postoperative morbidities as the dependent variable,and logistics regression analysis was performed;again univariate analysis is used to screen out potential risk factors,using major morbidities as the dependent variable,and logistics regression analysis was performed.Results:1.γ-glutamyltransferase（GGT）and alkaline phosphatase（ALP）decreased compared with those before surgery on 1^st after radical surgery for gastrointestinal tumors in cirrhotic patients,and the differences were statistically significant（P<0.05）.Then on the 7^th day after surgery,ALP andγ-GGT all recovered to their preoperative levels.Albumin（ALB）decreased consistently on the 1^st,7^th and 15^th days after operation,and the difference was statistically significant（P<0.05）.There was no difference between TBIL on the 1^st day after surgery compared with that before surgery,but it became higher on the 7^th day after surgery,and the differences were statistically significant（P<0.05）.2.According to the modified Clavien-Dindo system,the postoperative morbidities were classified.All included 60 case·times of grade I（50.4%,60/119）,37 case·times of grade II（31.1%,37/119）,and 13 case·times of grade III（10.8%,13/117）,7 case·times of grade IV（6.0%,7/119）,2 case·times of grade V（1.7%,2/117）.Among the 117 subjects included in the study,the incidence of postoperative morbidities was 49.6%（58/117）.The three postoperative morbidities with highest incidence were abdominal effusion（52cases,44.4%,52/117）,pneumonia（18 cases,15.4%,18/117）and pleural effusion（13cases,11.1%,13/117）.14 cases（12%,14/117）gained major morbidities after operation.3.Univariate analysis showed that gender（P=0.039）,preoperative CTP scores（P=0.008）,preoperative MELD scores（P=0.001）,preoperative platelet count（P=0.027）,operation duration（P=0.018）,intraoperative blood loss（P=0.001）and intraoperative transfusion（P<0.001）are associated with morbidities in cirrhotic patients after radical surgery for gastrointestinal tumors.Multivariate analysis showed that in CTP group,the preoperative CTP classification was B（OR=7.810,95%CI:2.328-26.200,P=0.001）and gender（OR=3.340,95%CI:0.928-8.393,P=0.019）are independent risk factors for postoperative morbidities;in MELD group,the preoperative MELD score between 10and 15 points（OR=6.541,95%CI:0.585-73.170,P=0.030）or more than 15 points（OR=11.417,95%CI:1.297-100.485,P=0.030）are independent risk factors for postoperative morbidities.4.Univariate analysis showed that preoperative CTP scores（P=0.001）,preoperative MELD scores（P=0.001）,preoperative creatinine（P=0.001）and intraoperative transfusion（P<0.001）were associated with the severity of morbidities in cirrhotic patients after radical surgery for gastrointestinal tumors.Multivariate analysis showed that in CTP group,the preoperative CTP classification was B（OR=17.076,95%CI:2.971-47.872,P=0.001）and intraoperative transfusion（OR=22.011,95%CI:3.212-90.779,P=0.001）are independent risk factors for major morbidities;in MELD group,the preoperative MELD scores between 10 and 15 points（OR=1.237,95%CI:0.181-8.439,P=0.009）or more than 15 points（OR=47.665,95%CI:3.985-570.103,P=0.009）and intraoperative transfusion（OR=12.140,95%CI:2.728-54.031,P=0.001）are independent risk factors for major morbidities.Conclusions:1.Radical surgery for gastrointestinal tumors in cirrhotic patients can easily lead to the progression of liver cirrhosis,so that it is necessary to strengthen liver protection treatment and perioperative care.2.Preoperative CTP scores,preoperative MELD scores,and gender are independent risk factors for morbidities in cirrhotic patients after radical surgery for gastrointestinal tumors.3.Preoperative CTP scores,preoperative MELD scores and intraoperative transfusion are independent risk factors for major morbidities in cirrhotic patients after radical surgery for gastrointestinal tumors.4.The morbidities or major morbidities of cirrhotic patients following radical surgery for gastrointestinal tumors could be reduced with risk stratification after reasonable preoperative assessment,adequate preoperative preparation,skilled surgical techniques and complete postoperative care.